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System Manager Payment Transformation

CommonSpirit Health
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Requisition ID 2021-184071 Employment Type Full Time Department Payer Relations Hours/Pay Period 80 Shift Day Standard Hours Mondy-Friday (8:00am - 5:00pm)
Overview

The System Manager, Payment Transformation leads the accounting and performance analysis activities for value-based agreements (VBA) and initiatives. Develops, recommends and assists with implementing strategies for maximizing reimbursement and market share from value-based programs and payment models. Monitors VBA participation and performance across the system using standardized tracking and reporting tools.  Develops new value-based initiatives with payers that are consistent with established strategic priorities. Provides education to key stakeholders.

This position will serve and support all stakeholders through ongoing educational and problem-solving support of value-based arrangements.  This role must be proficient in reading, interpreting, and formulating complex computer system programming/rules.


Responsibilities
  • Manage the labor and operations of the Payment Transformation team including the hiring, orienting, developing and managing of staff.
  • Prepare and effectively present VBA analysis results to senior leadership, and other key stakeholders, for review and decision-making.
  • Act as the Payer Strategy & Relationships leader liaison to leadership across CommonSpirit Health for tracking, reporting, updating and communicating VBA participation and performance information.
  • Develop and approve financial models for value-based agreements (VBAs) using SQL and Excel.
  • Analyze and publish VBA performance statements and determine profitability. Drive strategies and solutions in order to maximize VBA reimbursement and market share, which have multi-million or multi-billion-dollar impact to CommonSpirit Health. Review and accurately interpret VBA contract terms, including development of policies and procedures in support of value-based arrangement negotiations.
  • Provide training and oversight of the modeling of proposed/existing VBAs negotiated by payer strategy and relationships, including expected and actual revenues/volumes, population risk calculations, past performance, proposed contract language and regulatory changes.
  • Oversee the preparation of risk-share/gain-share funds flow models and financial distribution reports of VBA payments and repayments.
  • Create and/or manipulate data utilizing queries and scripts to mine and manipulate existing data in support of application test efforts. Works with Business Analysts, application teams, and Testers to analyze data requirements to support all phases of testing. Creates and maintains documentation and descriptors for data elements / attributes, and other required forms of metadata.
  • Oversee the identification, collection, and manipulation of data from a wide variety of financial and clinical internal database (e.g., Star, TSI, PCON, EPIC) and external sources (e.g., Medicare/Medicaid website). Identify and access appropriate date resources to support analyses and recommendations. Identify risk/exposure associated with various VBA reimbursement structure options. Oversee the production of analytical statistical reports on new ventures, products, services, being considered. Perform sensitivity analyses on operating and underlying assumptions such as modification s of charges rates.

Benefits Include: Benefits include Medical, Dental, Vision, Paid Time Off, Holidays, Retirement Program, Disability Plans, Tuition Reimbursement, Adoption Assistance, Employee Assistance Program (EAP), Discount Programs, Life Insurance Plans, Worker Compensation, Dress for Your Day Policy, Voluntary Benefits.

Compensation Range:  $ 49.20 to $63.96, hourly rates, annualized.

Position is eligible for incentive pay based on company performance.


Qualifications

Education

  • Bachelor’s Degree in Business Administration, Accounting, Finance, Healthcare or related field. Equivalent education and experience may be considered in lieu of degree.

Experience

  • Minimum of three (3) years leadership experience
  • Minimum of five (5) years of experience in Healthcare, insurance or related industry experience
  • Intermediate level working knowledge of SQL and Excel.
  • Intermediate knowledge of value-based arrangements, including shared savings, bundled payments, pay-for-performance, and capitation.
  • Must be able to lead and coordinate projects through various complex and challenging situations to completion under time-sensitive deadlines.
  • Must have working knowledge of healthcare financial statements or accounting principles.
  • Ability to use and create data reports from health information systems, database, or national payer websites (EPIC, EPSI, PIC, SQL Databases, NextGen, CMS.Gov, etc.)
  • Proficiency in reading, interpreting and formulating computer and mathematical rules/formulas.
  • Strong background in financial analysis.

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Equal Opportunity

CommonSpirit Health™ is an Equal Opportunity/Affirmative Action employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law. For more information about your EEO rights as an applicant, please click here.

CommonSpirit Health™ will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c). External hires must pass a post-offer, pre-employment background check/drug screen. Qualified applicants with an arrest and/or conviction will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, ban the box laws, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances. If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA). CommonSpirit Health™ participates in E-Verify.